Healthcare Provider Details

I. General information

NPI: 1740347202
Provider Name (Legal Business Name): MORTON MAX TEICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 PARK AVE
NEW YORK NY
10028-0209
US

IV. Provider business mailing address

930 PARK AVE
NEW YORK NY
10028-0209
US

V. Phone/Fax

Practice location:
  • Phone: 212-988-1821
  • Fax: 212-288-9289
Mailing address:
  • Phone: 212-988-1821
  • Fax: 212-288-9289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number97807
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number97807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: